PubMed Health⌕ Search

Biomedical subjects

R Chawla

Publications and source records attributed to R Chawla.

At least 19 recordsLinked to original sources
PubMed2006

Efficacy of intrathecal adenosine for postoperative pain relief.

BACKGROUND AND OBJECTIVE: Adenosine, by intravenous and intrathecal routes, is known to alleviate various types of pain. However, the role of intrathecal adenosine in providing postoperative analgesia has not been confirmed. The aim of the present study was to evaluate the efficacy of intrathecal adenosine for postoperative pain relief, and to determine its role for pre-emptive analgesia. METHODS: Ninety ASA I and II females, undergoing elective abdominal hysterectomy, were randomly divided into three groups of 30 patients each. Patients in the 'early adenosine' group received intrathecal adenosine 1,000 microg, 30 min before induction of anaesthesia. Patients in the 'late adenosine' group received the same dose before reversal of neuromuscular blockade. Control patients did not receive any test drug. A balanced general anaesthesia technique was used in all patients. Pain intensity scores using a visual analogue scale, sedation scores, time to first rescue analgesic and total morphine requirement were recorded. RESULTS: There was no significant difference in pain intensity scores, sedation scores, total morphine requirements and time to first rescue analgesic among the three groups. CONCLUSION: Intrathecal adenosine 1,000 microg is not effective as an analgesic for postoperative pain relief, and there is no pre-emptive effect.

Adenosine↗
PubMed2006

Epidemiology and outcome of bacterial meningitis in Canadian children: 1998-1999.

BACKGROUND: The introduction of Hemophilus influenzae type b (Hib) conjugate vaccine as part of the routine childhood vaccination schedule in Canada has resulted in a dramatic reduction in the cases of Hib meningitis. We describe the epidemiology and outcome of bacterial meningitis in Canadian children six years after the introduction of Hib conjugate vaccine and prior to the introduction of the conjugate Streptococcus pneumoniae vaccine. METHODS: A retrospective chart review from January 1998 to December 1999 of children with meningitis identified at eight Canadian tertiary care children's hospitals belonging to the PICNIC network. RESULTS: Bacterial meningitis was documented in 104 (11%) of 970 children presenting with meningitis. The most common isolated organisms were: Streptococcus pneumoniae (54%), group B streptococci (13%), and Neisseria meningitidis (11%). The mean age was 2.2 +/- 3.5 yr. Forty seven percent of the children required admission to Intensive Care Unit (ICU), and 19% required artificial ventilation. Sequelae were documented among 32 children (31%) prior to discharge and there were 6 (5.6%) deaths attributable to meningitis and sepsis. CONCLUSIONS: Bacterial meningitis is an important cause of morbidity in Canadian children with S. pneumoniae replacing H. influenzae as the leading potentially vaccine preventable cause. Despite proper initiation of antimicrobial therapy, meningitis results in great morbidity and mortality in children in Canada.

Bacterial Capsules↗
PubMed2005

An assessment of the impact of the proposed EU bathing water directive on Irish coastal bathing area compliance.

An assessment of the impact of the new microbial water quality standards of the proposed EU Bathing Water Directive on the classification of designated Irish coastal bathing areas is presented. The new standards are applied retrospectively to the microbial water quality results for the bathing seasons of 1999, 2000 and 2001, and the outcome is compared with that recorded under the present Bathing Water Directive. A Microsoft EXCEL application was developed to generate the retrospective bathing area classifications according to the proposed Directive (Excellent, Good, Poor). It was found that the number of Irish coastal bathing areas not attaining 'Excellent' classification (as would be required at present for the Blue Flag award) was trebled; the number attaining 'Good' classification was increased by about 50%, and the number attracting 'Poor' classification (equivalent to 'Fail' under the present Directive) was increased nine-fold. Some of the shortcomings of the proposed Directive and suggestions for its revision are discussed.

Bathing Beaches↗
PubMed2004

Community based study on sero-prevalence of syphilis in New Delhi (India).

Syphilis continues to be a major health problem in India. Data regarding sero-prevalence of syphilis is largely hospital based. Majority of community based studies have been conducted on select groups. Therefore, these studies do not reflect the true prevalence of syphilis in general population. The objective of the study was to determine the sero-prevalence of syphilis in the urban and rural communities of New Delhi, using both VDRL and TPHA for screening and FTA-ABS for confirmation and discrepant analysis. Serum specimens from 178 males and 227 females aged between 15-49 years were tested. VDRL test was put up using VDRL antigen from serologist, Kolkata. TPHA and FTA-ABS were performed using commercially available kits. 6.91% (28/405) subjects were found to be seropositive for syphilis (males 10.11%, females 4.40%). Syphilis seropositivity was found to be significantly associated with low income (p=0.02) and presence of symptoms suggestive of STIs (p=0.00) among males. Positive syphilis serology was significantly associated with trichomoniasis in females (p=0.00). Community based studies utilizing one non-treponemal test plus one treponemal test for screening purpose and an additional specific test for confirmation should be used for designing a control programme.

Adolescent↗
PubMed2003

Hemiretinal vein occlusion in Wegener's granulomatosis.

PURPOSE: To report a case of hemiretinal vein occlusion in a patient with Wegener's granulomatosis. RESULTS: Retinal vein occlusion may occur in patients with Wegener's granulomatosis even in the absence of active inflammation affecting the retinal venules. CONCLUSIONS: Wegener's granulomatosis should be considered in the diagnostic workup of young patients with major retinal vascular occlusion and concurrent history of pulmonary and/or renal disease.

Adult↗
PubMed2002

Respiratory failure in acute intermittent porphyria.

We report two patients of acute intermittent porphyria (AIP) who presented with acute respiratory failure. Only one such previous report could be found. Occasionally, neuropathy may be the presenting feature in AIP which may progress to respiratory embarrassment. The cause of this neuropathy has been hypothesized to be direct neurotoxicity of delta-ALA by interaction with GABA receptor, altered tryptophan metabolism and may be heme depletion in nerve cells.

Adult↗
PubMed2001

Successful transdiaphragmatic cardiac resuscitation through midline abdominal incision in patient with flail chest.

This case report describes a transdiaphragmatic approach through an already present vertical midline abdominal incision for performing internal cardiac compressions in a 30-year-old male road accident victim. The patient had a flail chest with haemopneumothorax and haemoperitoneum. Exploratory laparotomy followed by splenectomy was performed under general anaesthesia but the patient developed a witnessed cardiac arrest in postoperative period. Successful resuscitation using internal cardiac compression by a transdiaphragmatic approach through the midline abdominal incision that was not extended proximally is described.

Accidents, Traffic↗
PubMed2000

Global myocardial revascularization without cardiopulmonary bypass using innovative techniques for myocardial stabilization and perfusion.

BACKGROUND: In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique. METHODS: One hundred patients with severe triple-vessel disease underwent multivessel off-pump CABG. For cardiac stabilization, a combination of local pericardial stabilization sutures and lifting and rotating the heart by means of posterior pericardial sutures were used. For myocardial perfusion, a technique of retrograde coronary sinus perfusion by arterial blood from the ascending aorta was used. RESULTS: Each patient received an average of 3.8 grafts (range 3 to 5). Complications included conversion to cardiopulmonary bypass (CPB) in 1 patient and a perioperative myocardial infarction in the same patient. In all other patients we were able to perform a satisfactory grafting in all territories with no operative mortality. Rapid recovery allowed 95% of our patients to resume normal activity within 1 month. A predischarge graft angiogram in 35 patients showed 97.8% patency. CONCLUSIONS: These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.

Adult↗
PubMed1998

Asymptomatic methaemoglobinaemia and its implications.

Anaesthetists are well trained to detect subtle skin signs of life-threatening situations such as cyanosis in hypoxia. However, cyanosis resulting from drug-induced, asymptomatic methaemoglobinaemia is rare and is likely to go undetected preoperatively. Patients presenting with asymptomatic methaemoglobinaemia may, therefore, offer a dramatic challenge to the unprepared anaesthetist. We report a case of methaemoglobinaemia secondary to dapsone ingestion that was diagnosed intraoperatively.

Cyanosis↗
PubMed1992

Acute isoniazid poisoning.

We present two cases of acute isoniazid poisoning in patients who ingested 7.5 g and 5.0 g of isoniazid respectively, with the intention of committing suicide. Both were admitted unconscious, with ventilatory insufficiency and convulsions. Hepatic dysfunction and peripheral neuropathy were notable complications.

Acute Disease↗
PubMed1992

Can pulse oximetry be used to measure systolic blood pressure?

This study evaluates the use of pulse oximetry to accurately monitor systolic arterial blood pressure in 100 healthy volunteers. Determination of arterial blood pressure using oximetry was made at the disappearance of visual display upon blood pressure cuff inflation, at the reappearance of visual display upon cuff deflation, and by averaging the two. The blood pressures obtained by pulse oximetry were compared with the arterial blood pressures obtained by Korotokoff sounds and noninvasive blood pressure equipment. Good agreement was obtained when the average of oximetry-based systolic blood pressure estimates at the disappearance and reappearance of the waveform were compared with Korotokoff sound pressures and noninvasive equipment pressures. Thus pulse oximetry can be used to measure systolic arterial blood pressure. This technique is specifically important for patients with Takayasu's syndrome (pulseless disease) where conventional techniques often fail to monitor systolic arterial blood pressure.

Adult↗